Project Summary The Oglala Sioux Tribe (OST), or Pine Ridge Indian Reservation of South Dakota, has implemented the OST CHOICES Program to prevent alcohol-exposed pregnancies (AEP). However, while OST CHOICES was successfully implemented with adult American Indian women, a needs assessment with the OST community identified the critical need to prevent AEP among American Indian youth. Therefore, the overall goal of this project is to determine the feasibility and acceptability of the OST CHOICES Program among rural, American Indian teen females. To accomplish this, we will first utilize community input to revise and adapt the OST CHOICES Program curriculum for use with female American Indian adolescents aged 14-18 (SA 1). The target population will be involved in several rounds of formative qualitative work, leading to usability testing. The development of ?CHAT? (CHOICES for AI Teens), the revised OST CHOICES curriculum for female American Indian adolescents, will be based on input from the community and target population. We will pilot test CHAT with female American Indian adolescents at-risk for AEP, including utilizing technology-based follow-up data collection methods (SA 2). A subaim is to utilize an ecological framework to identify if early identification of American Indian girls for AEP prevention is a worthwhile investment. The impact of this project is the development of a transdisciplinary, community-based program to prevent AEP with female American Indian teens, an area of great need but with few current efforts. We will evaluate the flow of the full program and preliminary impact of the intervention, leading to preliminary data appropriate for testing within an R01-level, randomized controlled trial. Finally, we will expand current clinical practice by utilizing an ecological framework to impact not just AEP risk but also teen pregnancy risk and substance use behaviors.